在过渡到常规/模块化护理后,精神病早期干预服务是否保持其效果? 一个系统的审查和元分析
Gonzalo Salazar de Pablo1,2,3, Joao Almeida1, Jesus Camacho1,4
1Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
概括
对精神病的早期干预服务 (EIS) 在治疗期间显示出好处,但在停止治疗后,除了减少住院时间外,没有保持对常规护理/模块化护理 (UC/MC) 的优势. 建议对EIS进行进一步开发.
科学领域:
- 精神病学和心理健康 精神病学和心理健康
- 临床心理学 临床心理学
- 公共卫生 公共卫生
背景情况:
- 精神病早期干预服务 (EIS) 在分娩期间优于通常的护理/模块化护理 (UC/MC).
- 在过渡到UC/MC后,EIS的长期维持效应仍然不清楚.
研究的目的:
- 为了比较EIS与UC/MC的长期影响,在EIS停止后至少一年.
- 评估在干预期之后维持EIS福利的情况.
主要方法:
- 系统审查 (PRISMA,MOOSE合规) 的随机对照试验 (RCTs) 比较EIS和UC/MC.
- 在多个数据库中进行了搜索 (PubMed,EMBASE,PsycINFO,科学网,Cochrane).
- 六项 randomised controlled trials (RCT) 的元分析,涉及1416名患有早期精神病的个体,干预后至少12个月进行跟踪.
主要成果:
- 在干预期结束时,EIS护理显示出优于UC/MC (除了劳动参与和违法行为).
- 在EIS停止后的2-3年内,在住院,退学,生活质量,症状严重程度,工作参与,缓解,法律违法行为,抗精神病药物使用或自杀企图方面没有发现显著差异.
- 与UC/MC组相比,EIS组的住院时间显著减少 (SMD=0.128,p=0.021).
结论:
- 除了住院时间外,EIS护理在停止后的2-3年内并没有保持其优于UC/MC的优势.
- 调查结果表明,需要进一步开发和扩展EIS交付模型的可能性.
- 个性化或扩展EIS可能是必要的,以维持早期精神病患者的长期益处.
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